sexuality

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Remember “the little pink pill”? The great brouhaha last year about the FDA’s approval of “the female Viagra?”

Let us recap: The drug — flibanserin, brand name “addyi” — is aimed at boosting the libido in pre-menopausal women who have “Hypoactive Sexual Desire Disorder.” (In fact, it’s radically different from Viagra, aimed at desire rather than performance and taken daily, not as needed.)

The Food and Drug Administration declined to approve it twice, citing potential harms and marginal benefits. But then, in August — amid head-spinning debate about whether it’s sexist to approve a drug for female desire or sexist not to — the FDA said yes. Addyi went onto the market in October.

Now, a new meta-analysis, just out in JAMA Internal Medicine, sums up the handful of existing studies on the drug’s benefits — a resounding “eh” — and potential harms.

It finds that women who take the daily pill average just one additional “Satisfying Sexual Event” every two months. Compared to placebo, just 10 percent more women who take it report significant improvement in their sex lives.

“I think that what feminism means is getting good drugs that help more than they hurt.”

– Prof. Lisa M. Schwartz

As for harms, 21 percent of women on the drug reported severe drowsiness, compared to 8 percent on placebo. Of greater concern: When combined with alcohol, the drug can apparently lead to dangerously low blood pressure and even fainting.

The analysis confirms findings from before the FDA approval, and it’s not a very sexy picture. That could be why initial sales of Addyi seem to have been lackluster: Bloomberg reports that only a couple of hundred women got prescriptions for Addyi in the weeks after it was released, compared to the half million men who got Viagra in the month after it came onto the market in 1998.

So what’s the moral of this story? Drs. Steven Woloshin and Lisa M. Schwartz of the Dartmouth Institute of Health Policy and Clinical Practice wrote a biting editorial to accompany the meta-analysis, sub-headlined “Even The Score Does Not Add Up.”

“Even The Score” is the advocacy group that reportedly packed the FDA hearing room with women telling powerful stories of how desperately a treatment for loss of libido is needed. Woloshin and Schwartz write that it “conducted an intense promotional campaign directed at journalists, women’s groups, Congress and the FDA.”

The campaign, Schwartz says, “ignored the idea about the science and made it all about these charges of sexism, as opposed to the idea that there were real concerns about science here.”

“To me, as a woman, I think that what feminism means is getting good drugs that help more than they hurt — or non-drugs. I think it’s important to meet the needs of women, but we want to do that based on good science that tells us that we’re helping more than we’re hurting women. Even the Score started to become about something else.”

The moral, Woloshin says, is that while under such political pressure, “FDA approved a marginally effective drug for a non-life-threatening condition in the face of substantial and largely unnecessary uncertainty about its dangers.” Continue reading →

I’d read that parents can be a powerful force for smarts about sex, so I’d tried to script imaginary heart-to-hearts. But in my head, they all sounded like this: “Please don’t do these incredibly stupid things that I did when I was young.”

So I procrastinated, abetted by the younger generation’s point-blank refusal to let me even broach this most awkward of topics. Then, last year, word came home that middle-school health class would use a curriculum called “Get Real” that involved extensive family homework activities.

“Now I’m in for it,” I thought.

But in fact, I was in for a shockingly pleasant surprise — one that more and more parents may experience in the coming years if Get Real’s popularity continues to grow. As of this year, it has been adopted by 200 schools in seven states — 175 of them in Massachusetts. That’s up from 132 schools in 2012.

And in recent months, Get Real has scored two victories: An analysis by the Wellesley Centers for Women reported that students who go through Get Real do become likelier to delay sex, and the federal government put it on a list of “evidence-based” sex-ed programs.

No way is Get Real, which was created by the Planned Parenthood League of Massachusetts, for everybody. It strongly promotes abstinence as the healthiest choice for young people, but it’s not the sort of “abstinence-only” program that many parents and schools seek; it also includes teachings on birth control and preventing infection.

But perhaps more than any other curriculum out there, it pulls parents into the sex-ed endeavor, and here’s my pleasant surprise: It wasn’t awkward.

The Get Real homework prompted conversations about friendships, about feelings, about life lessons. I got to reminisce about my first crush, and talk about how important I think it is to stand up for yourself with a boyfriend or girlfriend. I even got to vent about how perniciously relationships are portrayed in that detestable high-school-girl series, “Pretty Little Liars.”

Sure, the course teaches intimate anatomy and the changes of puberty, but the body part it seemed to focus on most was the heart. It was teaching — well, love. Or rather, the skills that can make love better. Healthier. Skills like self-awareness and communication — useful in their own right, and also in service of sex-ed goals like preventing pregnancy and infections.

“We believe that if young people are able to develop healthy relationships in all aspects of their lives, they’re going to be that much better able to negotiate healthy sexual relationships,” says Jen Slonaker, vice president of education and training at the Planned Parenthood League of Massachusetts.

“The sad truth is that by the time young people get to college, it may be too late.”

At this national moment of rising discussion about campus rape — from “Missoula” to this week’s New Hampshire prep school trial — the need for such skills has never seemed more urgent. And they take time to develop, says Nicole Cushman, executive director of Answer, a national sex-education organization based at Rutgers University.

“When people talk about sexual assault and rape prevention on college campuses,” she says, “the sad truth is that by the time young people get to college, it may be too late, because we haven’t really laid the groundwork by teaching them these basic concepts about communication and relationships from a younger age. So I really believe that comprehensive sex education is sexual assault prevention.”

‘Red Flags’

Ashley, a Boston high school senior who is on the Get Real Teen Council, went through the curriculum beginning in middle school but says she really started seeing its effects when she got to high school.

“I know that what I learned in Get Real classes made me see certain red flags in my friends’ relationships and my own relationships, and helped me solve what I need to do in order to get away from the red flags,” she says.

One friend who took the class with her drew on it to resist sexual pressure, Ashley says: “She didn’t know if she was ready to have sex, and she touched upon the consent part — she was like, ‘I don’t have to do this, necessarily. It’s like — consent. It’s not fair. I don’t have to engage.’ ” Continue reading →

Possibly our juiciest segment yet, the latest installment of The Checkup podcast, our joint venture with Slate, takes on some sexual myths and offers a bit of reality.

We bring you surprises about penis size, stories of great sex over 70 and new insights on how both men and women are lied to about their sexuality. As we have in past segments, Carey and I offer our fresh take on research-based news that could brighten up your life below the waist. Check it out here:

And in case you missed our last episode, “Grossology” (including a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal) — you can listen now.

And if you want to hear earlier episodes: “Scary Food Stories” includes the tale of a recovering sugar addict and offers sobering news to kale devotees. And “On The Brain” includes fascinating research on dyslexia, depression and how playing music may affect our minds.

Make sure to tune in next time, when we present: “High Anxiety,” an episode on the (arguably) most prevalent of mental health disorders.

“You were taught to value and expect something from your sexuality that does not match what your sexuality actually is. You were told a story about what would happen in your sexual life, and that story was false. You were lied to. I am pissed, on your behalf, at the world for that lie. And I’m working to create a world that doesn’t lie to women about their bodies anymore.”

— From: “Come As You Are: The Surprising New Science That Will Transform Your Sex Life.”

I will be grateful forever to “The Hite Report.” Ditto “The Happy Hooker.” Certain books, at key moments, open our eyes to sexual reality — not the distorted reality of porn or bodice-buster novels, but the real-life reality of what our fellow humans do in private and how our own bodies and brains really respond.

I predict that for some, “Come As You Are” by Emily Nagoski — subtitled “The Surprising New Science That Will Transform Your Sex Life” — will be one of those books.

Nagoski, 37, is a sex educator, proud “sex nerd” with a PhD and past work at the Kinsey Institute, and director of wellness education at Smith College. (Also a blogger at thedirtynormal.com.) Her book focuses in part on a fine irony: Research over the last couple of decades in pursuit of a female version of Viagra — an effort that has failed — has nonetheless added new science to the study of women’s sexuality, science that can be applied to improve sex lives without any little pink pills.

Our conversation, lightly edited:

You say that we were lied to. How?

From the beginning, the day we’re born, the model of sexuality that all of us are given is the one that comes from the expectation of how male bodies work — mostly because, for so long, men were the scientists and the medical providers, they just sort of assumed that the way a man works is how women are supposed to work. So the extent to which a person in a female body does not match a person in a male body is the extent to which they have ‘failed’ to be sexual people.

And what are the ways that women are likeliest not to match?

There are two ways in particular. The first is in what’s called ‘arousal non-concordance.’ Arousal is the activity of your central and peripheral nervous systems in response to sexually relevant stimuli. And it turns out, for men there’s about a 50 percent overlap between what his genitals are doing and how turned on he feels. Basically, if his genitals are responding he’s feeling pretty turned on. That’s not always true, but largely.

“Sex is most satisfying for most women when you’re in a context that is low stress, high trust, high affection and explicitly erotic.”

– Emily Nagoski

For women, there’s about a 10 percent overlap between what her genitals are doing and how aroused she feels. And most of the time, that’s because women’s genitals tend to respond to sort of anything, it’s like a ‘just in case’ genital response. It doesn’t mean that she likes or wants what’s happening, it just means that it’s sexually relevant.

And we look at the way women’s bodies respond to sort of anything and we think, ‘Why don’t they actually like or want all these things? What’s going on with that?’ And it doesn’t mean anything is wrong. It just means the way female bodies work is not the way male bodies work. And that’s OK.

So arousal non-concordance means, if you’re a woman and you’re having genital response — wetness, blood flow — that doesn’t mean that, in your head, you’re necessarily turned on. And what’s another big one where men and women don’t match?

The other non-matching thing is in this idea of desire. The model we’re given is that desire should be spontaneous. It occurs out of the blue. You have one stray sexy thought and suddenly your engine is revving and you’re think to yourself, ‘I would like to go find someone to hook up with.’

And that spontaneous desire, out-of-the-blue desire, totally is one way people experience desire. And there’s another way of experiencing desire called ‘responsive desire’: You’re sort of in neutral, you’re reading a magazine, you’re flipping through channels, and your partner comes over and starts kissing your neck or caressing your arm, and every cell in your body goes, ‘Oh, right, that’s a really good idea!’ But it doesn’t occur spot out of the blue. It emerges in response to arousal, instead of the desire coming before the arousal.

You also discuss these interesting, research-based concepts of having a sexual ‘accelerator’ and sexual ‘brakes.’ How does that work?Continue reading →

In Dr. Abraham Morgentaler’s 26 years as a urologist who treats issues of male sexuality, he has seen thousands of patients, and “probably there hasn’t been a single one who hasn’t paid attention to his penis size on some level,” he says.

Combining 17 previous published studies for a total of 15,521 men, it amounts to the biggest review to date of medically measured penis size, says its lead author, Dr. David Veale of King’s College London. It processed the data into “nomograms,” or graphical diagrams, like the one above, familiar to parents as the typical form for the growth charts that pediatricians use.

From the press release on the paper (metric conversions mine), which is titled “Am I normal? A systematic review and construction of nomograms for flaccid and erect penis length and circumference in up to 15,521 men”:

The nomograms revealed that the average length of a flaccid penis was 9.16 cm [3.6 inches], the average length of a flaccid stretched penis was 13.24 cm [5.21 inches], and the average length of an erect penis was 13.12 cm [5.165 inches]. The average flaccid circumference was 9.31 cm [3.66 inches], and the average erect circumference was 11.66 cm [4.59 inches]. There was a small correlation between erect length and height.

So those are the averages, but the great beauty of a nomogram is that it can also give you a sense of the distribution of the variation, and you may have already noticed that the curve above looks strikingly flat. That is, there’s just not much difference, except at the extreme edges.

If your erect penis is 11 centimeters, that puts you down in the 10th percentile; if your erect penis is 15 centimeters, that puts you way up in the 85th percentile. Quite a jump, for a little over an inch.

“What’s interesting is, when you look at the curves, you see that most penises actually are fairly similar in size,” Dr. Morgentaler says. “You really have to go to the extremes — the top or bottom 5 or 10 percent — to really see some big differences. And truthfully, in my practice, I would say that’s exactly right. Most men have penises roughly the same size.”

But somehow, many men who are average think they’re below average. The study notes:

“Men may present to urologists or sexual medicine clinics with a concern with their penis size, despite their size falling within a normal range. This type of concern is commonly known as ‘small penis anxiety’ or ‘small penis syndrome.’ Continue reading →

October 6, 2014 | 1:17 PM | Alvin Tran

Sexting may be a new “normal” part of adolescent sexual development, reports a new study published Monday in the journal Pediatrics.

“The study results indicate that sexting may precede sexual intercourse in some cases and further cements the idea that sexting behavior is a credible sign of teenage sexual activity,” the study’s press release reports.

But what the study does not find is any link between sexting and high-risk sexual behavior. That lack of a link, the authors write, may suggest that “sexting is a new ‘normal’ part of adolescent sexual development and not strictly limited to at-risk adolescents.”

The researchers, based at the University of Texas Medical Branch at Galveston, analyzed data of an ongoing six-year study. It followed high school students in southeast Texas, who periodically completed anonymous surveys that measured various behaviors, including their history of sexting and sexual activity. After examining whether teen sexting predicted sexual behavior after a one-year follow-up, they found that the odds of being sexually active among those who sexted was 1.32 times larger than those who didn’t sext the previous year.

“In this temporal examination of the relationship between teen sexting and sexual behaviors, we found that sending naked pictures of oneself was associated with being sexually active one year later,” the authors wrote. But “counter to previous cross-sectional research, sexting was not temporally associated with risky sexual behaviors; and active sexting mediated the relationship between passive sexting and sexual intercourse,” they added.

Way back in 1988, children’s book author Robie H. Harris was sitting in a New York editor’s office batting around ideas for possible books. The editor proposed that she write a book about AIDS for elementary school children; she counter-proposed an all-encompassing look at “almost every single question that kids might have” about anything related to sex.

She rattled off a list of topics, and the rest is history: “It’s Perfectly Normal” is just out in its 20th-anniversary edition, with more than a million copies already in print. The mix of text by Harris and illustrations by Michael Emberley do indeed seem to cover all the sexual topics pubescent kids wonder about, from masturbation to menstruation to orientation to contraception.

“Of course,” Harris says, “over the years, I’ve added more topics as the times have changed, as information has changed, and as kids coming into puberty and adolescence have changed in some ways.”

What might those topics be? And what do they say about how kids’ worlds have changed over the last 20 years? Herewith, 10 significant changes in the book and what Harris says about them:

1. The Infosphere:“There can be a lot of inappropriate, weird, confusing, uncomfortable, creepy, scary or even dangerous websites that you can end up on when looking for information.”

The biggest change in kids’ lives over the last 20 years, Harris says, is how they get their information. “With the explosion of information happening everywhere, kids are bombarded by sexual images, sexual words, words in songs. And then there’s the Internet: Kids can go on the Internet and find responsible information, and they can also go on the Internet and find information that is not accurate and sometimes absolutely dishonest.“

“And so the biggest change is the need to help kids know how to understand the information you get, and how do you get help with it? That’s when you go to a trusted adult. There’s just much more information to sort through for kids, and that’s why the biggest expansion in the book is the Internet chapter.”

And just a note on porn: Harris says every mental health expert she consulted says youngsters should stay away from it. (The book is for age 10 and up.) So “It’s one of the few judgments I put into the book, because I think it has to do with the health and wellbeing of our kids.”

2. Gender“Gender is another word for whether a person is male or female. Gender is also about the thoughts and feelings a person has about being a female or being a male.”

Author Robie H. Harris (Courtesy Candlewick Press)

That’s the broader definition of gender in the opening chapter, and the new edition also includes an explanation of “transgender” and “LGBT.” Harris acknowledges that the section on transgender youth “should have been in the book earlier, but it’s in there now.”

The section also includes a discussion of some people’s disrespect for gay and transgender people, and says it generally stems from ignorance. “I can’t write without a point of view,” Harris says. And her litmus tests has always been, “Is this what I would say to my own children?”

3. Long-acting birth controlThe IUD, the implant and Depo-Provera are the most effective kinds of birth control.

The ranking of the most effective birth control methods is new, Harris says. It reflects a strong consensus among medical authorities that those long-acting methods are appropriate for teens who become sexually active — and desirable because they’re by far the most effective: they require no further action by the user — no daily pill, no pause for diaphragm insertion. Continue reading →

February 14, 2014 | 11:55 AM | Dr. Aline Zoldbrod

Imagine you’re a stereotypical “old lady,” with a lined face and gray hair, walking down the street. Some young guy looks at you and thinks, “How ya doing, grandma, you old coot? Are you wearing your Depends?” Actually, no, you think, you’re wearing nice underwear because you’re going to meet your beloved to see a movie, then go home and have some really delicious sex, replete with leisurely foreplay and plenty of laughter. You pass a juicy 38-year-old walking down the street with her two little kids in tow, and think, “Poor dear. She won’t have really good sex again for a good 20 years.”

This is not tabloid fantasy: “Sexually Active Septuagenarian!” It is possible. Not for everyone — but for a substantial minority, perhaps a fifth of women or more. And I’ll tell you why, based on research and my experience as a sex and couples therapist — but first, what gives? Why are we suddenly talking about this squirmy topic?

It’s because author Iris Krasnow has a new book out, “Sex After…,” subtitled “Women Share How Intimacy Changes As Life Changes.” And it includes women in their 70s and beyond who are having a glorious time, sexually. Some have partners; others have just discovered the joys of solo sex; some are having their first orgasms ever, thank to vibrators and toys now available for anyone to order online.

People have an ‘ick’ reaction to thinking that their parents are being sexual, let alone their grandparents.

Krasnow writes about the 77-year-old who “was inspired to try fellatio for the first time after watching a how-to video on YouTube.” And she shares the story of another woman in her 70s, a recent widow, who met up with a male friend she had not seen for 54 years and who went to bed with him on the first date, staying in bed having sex with him for five hours.

I’m thinking that this book excerpt is going to blow a lot of people’s minds. Even the “Granny Porn” websites have women who are ages 40 to 50. Women in their 70s?? Most of what you’ll find if you look up “sex over fifty” online talks about frail vaginal tissue, lack of lubrication and flagging erections. Those accounts are accurate but psychologically conservative.

In contrast, the denizens of Krasnow’s research don’t talk about any of the physical barriers to erotic pleasures. This is a group of women who are sexual explorers, women who want to have as much sexual pleasure as they can. They are what psychologist Dr. Abraham Maslow would probably call “sexually self-actualized.”

Krasnow’s findings, while based on a very small sample of older women, actually fit with academic research on the sex lives of older people. Surveys repeatedly find that there is a cohort of men and women, ranging in age from their 60s to their 80s and above, who are having active, enjoyable, single or partnered sex lives. They tend to be healthy and active people, and their attitude about what it is to have a sexual relationship and to be a sexual human being has flexed with age, so that standards are less perfectionistic and performance driven, and the physical changes of aging can be taken in stride.

There is a cultural stigma associated with talking about the sex lives of the elderly. People have an “ick” reaction to thinking that their parents are being sexual, let alone their grandparents. But times have changed. Continue reading →

“I’m at the age where a lot of my friends are getting married. But I can’t even get up the courage to date. I’m 26, and I’ve got a good job, but I feel like a total freak. My life is stalled. I’m getting more and more isolated and depressed. I just can’t seem to maintain any sexual interest in girls. Hell, I can’t maintain that much interest in a girl in any way. I can’t get turned on. I can’t get an erection. And I’m getting too paranoid to ask any girl out on a date. What if she tells her friends that I can’t perform?”

It turns out that Bill has been watching Internet porn since he was 13. There was not a lot of love or supervision in his family. His dad drank, and his mom was overwhelmed with the stress of taking care of the kids and being the wife of an alcoholic.

For a long time, he masturbated to the porn. In the last few years, he has found himself just watching the porn for hours on end, just clicking his mouse like a zombie, trying new scene after new scene to get enough of a hit to stay aroused, but not even masturbating. Besides work and eating, all he does is stay glued to the screen.

You may have seen the recent film Don Jon, featuring Joseph Gordon-Levitt as Jon, an Internet porn addict whose habit hurts his love life. I see too many Jons in my office — men like Bill.

I can think of plenty of good uses for pornography. I’ve seen it help some of my patients, enrich their lives. And I know that in writing this piece, I’m stepping into a hornet’s nest. Pornography is a very loaded topic, a value-laden one. Many colleagues who are sexologists don’t agree with me, nor do champions of free speech.

From “Don Jon” (YouTube)

But I see a sexual and relational train wreck happening, and I need to speak out. Parents and policy-makers, beware: Something very bad is happening out there with teenagers and pornography. Internet porn has the potential to change some adolescents’ sexual development in a very damaging way: It can ruin or hinder their ability to form sexual relationships.

Here’s the thing: When sex is good, it’s a wonderful part of life. I would hope that even the most conservative among us would wish that when our children grow up, they could have pleasurable sex with a beloved partner.

But if the current trend with teenagers and porn continues, there is going to be a new generation of adults who lost an important step in their sexual development and who have trouble, as young adults and later in life, integrating emotional attachment and love with sexual expression and sexual pleasure. Masters and Johnson did not call sex “the pleasure bond” for nothing.

Dr. Aline Zoldbrod

This is not a new issue. The 60s and 70s saw sexploitation and snuff films, and porn has been traded on the Internet since the 1980s. But films and early porn cost money. Beginning in the 1990s, the amount of free porn exploded; the types of porn available online became ever darker and more insidious; teenagers began accessing it; and now we’re seeing the daunting results.

Recently, a new documentary has come out that illustrates the negative effects that pornography can have on teenage boys. I urge you to watch it here.

The patient was not complaining, by any means. He’d just started a new “natural” sex enhancement supplement, and he reported that it was working terrifically.

But Dr. Pieter Cohen’s astute resident at the Somerville Hospital primary care clinic, Dr. Rachael Bedard, had her suspicions, and she brought the patient to his attention. Dr. Cohen, a general internist at Cambridge Health Alliance and a frequent medical mythbuster, sent the pill out to be tested.

“The lab not only found Viagra in it,” he recalled. “They also found Cialis, another erectile dysfunction drug, as well as a brand new designer drug, as well as caffeine.” So in all, “You’ve got two prescription drugs that we would never prescribe together, a brand new drug, and caffeine, all in one pill. And that’s what our patient was consuming when he thought he was taking a natural sex enhancer.” In fact, the supplement, Sex Plus, was “chock full of pharmaceuticals that had nothing to do with nature.”

Dr. Bedard sent the findings to the FDA, which did its own testing and ended up issuing this alert late last month. And Dr. Cohen has just co-authored a paper in the Journal of the American Medical Association Internal Medicine — “Adulterated Sexual Enhancement Supplements,” subtitled “More Than Mojo” — spreading the word that sex-enhancement supplements advertised as natural may in fact be nothing of the kind. And they may contain brand new designer erectile-dysfunction drugs whose potential dangers are anyone’s guess.

His bottom line: “If you want a natural sex enhancer, talk to your doctor about prescription ‘yohimbe,’ but it may have side effects and it’s not very effective. Still, if you want to avoid Viagra, that’s the way to go. When it comes to any supplement sold for sexual enhancement, it should be avoided because it’s either going to be useless or potentially harmful.”

What might be the danger of, say, the drug that Somerville patient was taking? Continue reading →

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.GET IN TOUCH

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Massachusetts is the leading laboratory for health care reform in the nation, and a hub of medical innovation. From the lab to your doctor’s office, from the broad political stage to the numbers on your scale, we’d like CommonHealth to be your go-to source for news, conversation and smart analysis. Your hosts are Carey Goldberg, former Boston bureau chief of The New York Times, and Rachel Zimmerman, former health and medicine reporter for The Wall Street Journal.

If they’re so effective, why aren’t more women using IUDs and implants? A health clinic in Worcester is getting help to put better birth control front and center — particularly long-acting birth control, in hopes of cutting the high rate of unintended pregnancy.